Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p<0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p<0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

Assessment of serum irisin level in thyroid disorder

Background Irisin is a newly discovered myokin secreted by myocytes responsible for transmission of signals from muscles to other body tissues. Irisin improves systemic metabolism by increasing the energy expenditure. Owing to numerous similarities in action between irisin and thyroid hormones it seems imperative to explore these substances’ potential mutual influence on the body. Objective To estimate serum irisin concentration in patients with hypothyroid and hyperthyroid diseases, and to detect the relation of serum irisin in patients with thyroid disorders with creatine kinase (CK), a serum marker of muscle damage. Patients and methods The study comprised 30 hyperthyroid patients (group 1), 30 hypothyroid patients (group 2), and 30 normal persons (group 3). Irisin was measured using enzyme-linked immunosorbent assay. Thyroid-stimulating hormone, triiodothyronine, and free thyroxine levels were measured using chemiluminescent microparticle immunoassay technology. Results Irisin hormone level significantly decreased in hypothyroid patients in comparison with hyperthyroid patients. Irisin hormone level increased in hyperthyroid patients in comparison with normal persons, whereas it decreased in hypothyroid patients in comparison with normal persons. CK level significantly decreased in hyperthyroid patients in comparison with hypothyroid patients. CK level significantly increased in hypothyroid patients in comparison with normal persons, whereas it significantly decreased in hyperthyroid patients in comparison with normal persons. Conclusion Obtained results suggest the influence of thermometabolic state on irisin level

Assessment of a wind energy conversion system based on a six-phase permanent magnet synchronous generator with a twelve-pulse PWM current source converter

The steady-state and dynamic performances of a new high-power variable speed wind-energy conversion system (WECS) that uses a six-phase permanent magnet synchronous generator (PMSG) with twelve-pulse back-to-back pulse width modulated current source converters is assessed. The proposed WECS inherently has all the features of existing systems based on voltage source converters, such as voltage control and fault ride-through capability, but with increased reliability and improved ac side waveform quality, benefiting from the three-winding phase shifting transformer for further attenuation of the low-order harmonics. PSCAD/EMTDC simulation is used to assess the steady-state and dynamic behaviours of the proposed system under different operating conditions. Experimental results, obtained using a prototype grid side dual current source inverter (CSI), are presented to validate the proposed technique

Thermal perturbations beneath the incipient Okavango Rift Zone, northwest Botswana

We used aeromagnetic and gravity data to investigate the thermal structure beneath the incipient Okavango Rift Zone (ORZ) in northwestern Botswana in order to understand its role in strain localization during rift initiation. We used three-dimensional (3-D) inversion of aeromagnetic data to estimate the Curie Point Depth (CPD) and heat flow under the rift and surrounding basement. We also used two-dimensional (2-D) power-density spectrum analysis of gravity data to estimate the Moho depth. Our results reveal shallow CPD values (8-15 km) and high heat flow (60-90 mW m-2\u3e) beneath a ~60 km wide NE-trending zone coincident with major rift-related border faults and the boundary between Proterozoic orogenic belts. This is accompanied by thin crust (\u3c\u3c30 km) in the northeastern and southwestern parts of the ORZ. Within the Precambrian basement areas, the CPD values are deeper (16-30 km) and the heat flow estimates are lower (30-50 mW m-2), corresponding to thicker crust (~40-50 km). We interpret the thermal structure under the ORZ as due to upward migration of hot mantle fluids through the lithospheric column that utilized the presence of Precambrian lithospheric shear zones as conduits. These fluids weaken the crust, enhancing rift nucleation. Our interpretation is supported by 2-D forward modeling of gravity data suggesting the presence of a wedge of altered lithospheric mantle centered beneath the ORZ. If our interpretation is correct, it may result in a potential paradigm shift in which strain localization at continental rift initiation could be achieved through fluid-assisted lithospheric weakening without asthenospheric involvement

Terrestrial heat flow in the Malawi Rifted Zone, East Africa

This is the data file of the geothermal parameters which include, Curie point depth, geothermal gradient and heat flow for the Malawi Rifted Zone derived from aeromagnetic data

Development and validation of a predictive scoring system for in-hospital mortality in COVID-19 Egyptian patients: a retrospective study

Abstract SARS-CoV-2 virus has rapidly spread worldwide since December 2019, causing COVID-19 disease. In-hospital mortality is a common indicator for evaluating treatment outcomes. Therefore, the developing and validating a simple score system from observational data could assist in modulating the management procedures. A retrospective cohort study included all data records of patients with positive PCR for SARS-CoV-2. The factors that associated with mortality were analyzed, then allocation of potential predictors of mortality was executed using different logistic regression modeling, subsequently scoring system was developed from the most weighted predictors. The mortality rate of patients with COVID-19 pneumonia was 28.5% and 28.74%, respectively. The most significant factors that affected in-hospital mortality were old age (> 60 years), delay in hospital admission (> 4 days), high neutrophil/lymphocyte ratio “NLR” (> 3); higher computed tomography severity score; and CT-SS (> 20), in addition to using remdesivir and tocilizumab in the treatment protocol (P < 0.001 for all). The validity of the newly performed score was significant; the AUC was 85%, P < 0.001, and its prognostic utility was good; the AUC was 75%, P < 0.001. The prognostic utility of newly developed score system (EGY.Score) was excellent and could be used to adjust the treatment strategy of highly at-risk patients with COVID-19 pneumonia